What type of doctor performs vaginal rejuvenation? Plastic surgeon, OB/Gyn or Urogynecologist?

Im a 36 year old mother of two. My vagina feels loose, I urinate during sex and my OB/GYN told me I have a rectocele. I've tried biofeedback 7 years ago. The rectocele has caused problems with bowel movements. My question is what procedure do I need and what type of doctor do I go to. I've heard so many terms, vaginal rejuvenation, vaginoplasty,rectocele mesh repair, A&P. My biggest concern is can I have rejuvenation with a rectocele? I want to feel sex again and have a tight vagina.

Doctor Answers 13

Choosing the right Vaginal Rejuvenation Surgeon

It's great that you are doing your research to ensure that you have the best surgical outcome.  Vaginal rejuvenation (aka--vaginoplasty, vaginal tightening)--is usually accomplished utilizing traditional surgical techniques for real medical problems.  My partner, Dr. John Miklos and I rarely see a patient that does not have a real medical condition, these conditions are known as prolapse (i.e. cystocele, rectocele, enterocele, uterine or vaginal vault prolapse).  It is the act of surgically treating these conditions which tightens the vagina.  Most surgeons do not consider vaginal rejuvenation as a medical procedure to correct a medically necessary condition, instead they simply consider it a cosmetic procedure.

To answer your biggest concern, yes you can have vaginal rejuvenation with a rectocele.  To correct your rectocele you would need a Posterior Repair. 

Most importantly, you will need to find a surgeon that specializes in the repair of female pelvic reconstruction and vaginal rejuvenation.  Typically this would be a Urogynecologist.  Someone that has additional speciality training after completing residency in Obstetrics and Gynecology.   Urogynecologists undergo fellowship training where they spend several years focusing only on these disorders.  


Atlanta Urogynecologist
5.0 out of 5 stars 7 reviews

Who (what type of surgeon) should perform vaginal tightening and pelvic support operations

Hello "Casey,"

Although an occasional Plastic Surgeon will perform intra-vaginal surgery, pelvic support operations and vaginal tightening surgery for reasons of improving sexual function are the pervue of experienced Gynecologists and Urogynecologists.  Unfortunaltly however, the vast majority of Gyn's and Urogyn's, although they may be well-experienced in site-specific repairs, pelvic floor support procedures, and tape/mesh incontinence operations, have little vision when it comes to modifying these operations to include vaginal tightening, elevation and strengthening of the perineal body, and fashioning an aesthetically pleasing finish to the introitus (vaginal opening).

These are elements that certainly any experienced Gyn surgeon could learn, but most do not take the time.  So... for you: find an experienced Gyn or Urogyn for your support surgery, and negotiate with her or him to modify their surgery to include overall vaginal tightening; make sure they are aware, and note in their records, that the "look" of the opening, approximation of the "levator" muscles, overall minimization of vaginal caliber, and post-operative pelvic floor physical therapy for improving muscular strength are important for you.

Or... find an experienced cosmetic Gynecologist or Urogynecologist.  With the advent of improved retractor systoms, some of us (myself included) now perform these surgeries in our office surgical suites under local anesthesia, a strong plus for overall comfort, better recovery, improved safety, and significantly lower overall cost.

For additional information, please refer to the link below...

Michael P Goodman MD

Best Surgeon for #VaginalRejuvenation

Candidates of Vaginal Rejuvenation or Vaginoplasty surgery are women who desire a more youthful appearance and function of the vulvas and vaginal area. For some women, the effects of childbirth, aging, trauma, and/or genetics, causes their vaginal tissue and muscles to become stretched, which results in loss of strength and tone in the vaginal area. This can lead to unsatisfying intimate contact and discomfort.
These surgeries are best performed by carefully selected Plastic Surgeons or Gynecologists. As this is not a very common procedure it is important that you choose a specialist who has significant experience in these procedures to get the best result with the least number of complications. See the below link on how to find the most experienced surgeon. 

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Best doctor for vaginal rejuvenation

Best doctor for  #vaginalrejuvenation
Rejuvenation can be performed by any of the specialties you
mention.
As the problem becomes more complicated, you should seek a gyn who is experienced in these procedures.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Any of these, as long as...

Any of these may perform the procedure as long as they have the proper training and understanding of the anatomy and functional changes that this type of surgery causes.

Jabal Uffelman, MD
Fort Lauderdale OB/GYN

Urogyn is best

Great question!  Since you have had two (vaginal?) deliveries, it seems as if you are also suffering from stress urinary incontinence in addition to your rectocele.  As a practicing urogynecologist, I start with non surgical techniques such as physical therapy tailored to the pelvic floor before proceeding with more invasive procedures.  Since you have a real clinical problem, your procedures (if necessary) should be covered by your insurance as well.

Hope this helps!  

-Dr. W.

Rectocele repair and vaginoplasty...two different things

What you are going through is not uncommon in women after childbirth.  A Rectocele is a defect of the wall between the rectum and the vagina. This is best repaired by a gynecologist or urogynecologist.  As others have mentioned, not all gynecologist are trained in feminine rejuvenation.  This would include vaginoplasty (part of a vaginal rejuvenation procedure), labiaplasty, clitoral hoodectomy to name a few. Cosmetic Gyn surgery is performed by trained gynecologist, plastic surgeons, and urogynecologist. But since you have two issues, it may be best to seek one surgeon, in this case a cosmetically trained gynecologist for a one stop surgery.  Best of luck. 

Vaginal rejuvenation and labiaplasty

This is a specialized area for rejuvenation and you should find a surgeon certified by the American Board of Plastic Surgery who has a lot of experience in this arena.

I evaluate three parts of the perineum: labia majora, labia minora (and prepuce, or clitoral hood), and the vaginal muscle sling.

Labiaplasty is commonly performed in the office with excellent results and little risk.  There are several approaches to this; the best plan is an individualized one for each specific patient.

For true "vaginaplasty" the entire muscular tube of the vagina is tightened.  This is a bigger procedure, performed in a hospital, and should not be confused with hymenoplasty where just the outermost portion of the vaginal orifice is tightened.  

Most women with lax or patulous vaginas derive significant improvement in vaginal tone from exercise alone (do an on-line search for a device called the KegelMaster 2000).  

When there has been muscular damage or scarring (usually from childbirth) then a full repair is done.

Vaginal reconstructive surgery

This surgery should be performed by an experienced board certified gynecologist and possibly on who has additional training in urogynecolgy.  Most plastic surgeons who do surgery in this area are doing labiaplasty, which is limited to reduction of the external labia minora (inner lips) or modification of the labia majora (outer rounded lip area).  Strictly speaking I do not consider labiaplasty as vaginal rejuvenation for 2 reasons.  The surgical procedures are mostly outside the vaginal canal, and it is not tissue that is being "rejuvenated". There are more patients seeking labiaplasty during their younger years than older years.  Follow your gynecologist's recommendations. I hope that this hleps.

John M. Weeter, MD
Louisville Plastic Surgeon
5.0 out of 5 stars 6 reviews

Who should perform a rectocele repair.

It sounds like you have several issues that are playing a role besides needing a vaginal tightening procedure.

Having both a rectocele and cystocele may indicate that you have vaginal wall weakening and organ prolapse.   I would strongly encourage you to seek an Gyn surgeon with experience in dealing with these issues or a urogynecologist who is trained in dealing with these specific issues.
The good news is that the rectocele and cystocele that are causing your quality of life issues can be fixed and in the process you can have a vaginal tightening procedure.

Hope that helps.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.